Baclofen in alcohol use disorder: mechanisms, efficacy and clinical applications

Alcohol use disorder (AUD) is a significant global health concern, contributing to millions of deaths and various health complications including liver disease or cardiovascular issues. Despite the availability of several pharmacological treatments for AUD, success rates remain modest, emphasising the need for more effective therapies. Baclofen, a GABA-B receptor agonist, has been explored as an off-label treatment for AUD due to its capacity to modulate brain reward systems and the hypothalamic–pituitary–adrenocortical axis. Baclofen can reduce alcohol cravings and increase abstinent days especially in individuals with alcohol-related liver disease. It may also help prevent relapse by lowering stress-induced cortisol levels, which are linked to alcohol-seeking behaviours. While side effects like sedation and dizziness are common, more severe adverse effects have been reported. However, the available studies have limitations like small sample size, varying dosing regimens and inconsistent outcomes. What is more, well-controlled trials are required to fully understand baclofen’s mechanisms, its optimal dosing and long-term effectiveness in treating AUD. Despite these gaps, baclofen remains promising as an important tool in supporting recovery and preventing relapse in AUD patients.